This study will pursue three specific aims: 1) to refine a conceptual framework and methodological approach for clarifying the relationships between global trade and U.S. health policies; 2) to assess the decisions and actions of major groups participating in policy debates concerning globalization, health care, and public health in the United States: U.S. government agencies, multinational banking and trade organizations, international and national health organizations, multinational corporations, and advocacy groups; and 3) to present recommendations for policy changes that link globalization, health care, and public health. As encouraged by the AHRQ Small Research Grant Program, the investigators will conduct pilot research in an arena of health policy that previously has remained unexamined. Economic globalization raises fundamental problems for U.S. health policy. The World Bank and other international lending agencies have fostered reduction and privatization of public-sector health and public health services; this intensely debated orientation has affected policies of the World Health Organization, the Pan American Health Organization, and the U.S. National Institutes of Health. Expansion of multinational corporations (managed care organizations, consulting firms, pharmaceutical and medical equipment firms, and industrial corporations) has led to environmental and occupational health effects, unemployment, loss of health insurance benefits, and withdrawal from U.S. Medicaid and Medicare markets. Growing from previous research on the exportation of managed care and the implementation of Medicaid managed care, the proposed work includes an analysis of the research and archival literature on globalization and health policy; interviews with representatives of government agencies, multinational banking and trade organizations, international and national health organizations, multinational corporations, and advocacy groups; and assessment of these organizations' reports available in the public sphere. This project will lead to several products: two journal articles, op-ed and similar articles for newspapers and magazines, a book, and a curriculum module for policy studies, public health, social sciences, and management